An Exploration in Caring for those with Dementia - Essay Example

 An Exploration in Caring for those with Dementia Abstract Dementia is a life altering cognitive disease that normally targets those within the elderly population. The research in this compiled literature discusses the needs and expectations that those with early stages of dementia might expect from their caregivers. It discusses the issues that quite commonly affect the family members involved with the facilitated care for their loved ones who are sufferers of this mental illness as well. The style of the research does have a somewhat reflective quality to give emphases to the reality of the mental illness. There are many things that caregivers can do to make those who have dementia feel more comfortable and of which allow them to still have some independence in the early stages of the illness. The conclusion shows that although there is no cure for this disease there are many ways in which the quality of life can be ensured as appropriately as possibly. It gives pause to allow for contemplation into the fact of how an individual would feel if they themselves where diagnosed with such an illness and what they would want and expect in their own care. The main point of the research is that all individuals deserve quality care and a degree of respect despite what their medical condition might be. An Exploration of the Issues in Caring for those with Dementia Introduction The disease of dementia targets the cognitive processes in the brain which gradually create confusion and lack of understanding by the individual over a specific period of time. Medical researchers have gathered enough data about this disease to feel sure that it can be labeled an organic brain syndrome which does bring about severe cognitive impairments in an individual. It can also occur due to a variety of neurological diseases that a person might have been diagnosed with. To bring more cohesive thought into this description of the disease there are more widely known dementing illnesses such as Alzheimer’s disease (AD), Multi-Infarct Dementia (MID), and Huntington’s Disease (HD), than simply dementia alone (Beach 1987). All of these are relatively similar to dementia in that they all cause great distress in the cognitive working areas of the brain, gradually bringing about incoherency and a lack of understanding from the individual who has the illness or illnesses. Alzheimer’s however, which is the most understood dehabilitating cognitive disease is more prominent within the elderly population, occurring in over 50% of demented patients (Beach 1987). From a clinical perspective, the disease of dementia is greatly like delirium, except for time expanse of the diseases that are varied. The disease of delirium happens to be an acute transitory disorder where as dementia in itself is a progressively long term mental disorder that slowly causes deterioration of the mental processes in the mind such as the ability to tie a show lace or for one to be able to feed themselves. The actual course of AD has been interpreted to range from 1 year to 1.5 years with an estimated length of approximately 8.1 years (Terry 1988). There are also three stages of AD which range from mild symptoms within patients to severely incapacitated individuals. It is within these three stages that medical professionals have observed how systematic the progress of the disease actually is as patients go from being able to communicate to confusion and sometimes regressive states to not being able to function on their own whatsoever. The milder form of dementia begins with memory, attention, speed dependent activities, and the abstract reasoning that patients might have (Lezak 1993). There are also language impairments that are quite noticeable as well. In the next stage which is labeled the “moderate stage”, language deficits such as aphasia, apraxia slowly begins to become more pronounced. Dissiliency, paraphasias, and bizarre word combinations impair the individuals’ ability to speak freely and make logical sense in their statements. Also their auditory capabilities are severely impacted with many patients becoming mute or not seemingly being able to hear at all. It is in the last and final stage that patients progress to a total vegetative state where they are unable to care for themselves in any way and require 24 hour nursing care which is why many of these elderly patients end up in the nursing home environments. There are also two dimensions that are differentiated within the disease of dementia and these are age and the cortical level (Vinkers et al, 2003). Within the first dimension, age is a big factor as it is why deciphers the symptoms between senile and presenile dementia, where big differences are sometimes hard to determine. The senile phase of dementia is often used to describe patients who become demented after 65 years of age. Presenile dementia is applied to those patients who became demented before the age of 65. Studies have shown that the late onset of dementia is the most common and it affects the higher percentile of people within an elderly population (Vinkers et al, 2003). Within the second phase of dementia there are often different stages of dementia that can be found. For instance some patients will have lesions on the brain which are at the cortical level of the brain, but others might not, defining the facts that each patient can be different and the diagnosis is not always the same either so therefore diagnosing dementia within a patient is not as simple as some medical professionals perceive it to be at times. Emotional States of Dementia Patients In the early stages of dementia, those diagnosed with this degenerative disease often go into a very sudden and unexpected depression. The signs of this could be crying for no apparent reason and then suddenly laughing at nothing as well. Mood swings, isolation, minimal communication, limited auditory responses, and other emotional signals are definite side affects of the illness as the individual attempts to cope with the diagnosis that they have been given. Depression is often one of the most common emotional states that those in the early stages of depression end up trying to overcome and for them it is very difficult because there mental state is already weakened (Beckleman 1990). A subsequent emotional status of those with dementia is the inability to sleep appropriately following their hearing the diagnosis. This often leads to agitation and exhaustion due to the sleep order that they develop. This adversity can be detrimental to their already lowering health so intervention in the form of sincere care and understanding is always put in place, with encouragement by medical professionals to families to spend as much time with their loved one as possible. As was stated, they also socially withdraw from many public activities that they once might have been fond of. For instance, the grandmother who use to attend every Wednesday crochet night suddenly exits from the scene and refuses to answer her phone. This is a clear and evident sign that there is a medical condition which is leading to adverse emotional states for a patient (Frank 1985). Of course it is highly understandable why patients diagnosed with dementia react in the emotional way that they do. I personally believe if I were confronted with such a boggling diagnosis I might crawl into my own mind for a little while as well. I believe that some individuals have a harder time coping than others and still even more so, many people become bitter and angry following such a diagnosis, not seeing the fairness or logical reason in their health condition. This is understandable as well for again, if I were the patient diagnosed with dementia I would feel lost, confused, bewildered, and just about ready to cave in to it all and possibly not even attempt to try and combat it. This is how many dementia patients do react and some more adversely than others. Perhaps this is due to the fact that it is widely known that dementia has no cure and as it progresses the various stages of it take more and more of a person’s life away. I don’t feel that anyone wants to lose their own identity yet with this disease it is exactly what happens. Therefore it is quite logical while emotions are rather unstable and a person can go from telling a joke and laughing with old time friends one minute to absolutely following totally apart in the next thirty seconds. As stated, dementia patients don’t have very good control over their emotions, even in the earliest stages. Of course their families attempt to be understanding and offer support but a percentage of elderly people shun this type of assistance, refusing to accept what is happening to them and therefore living in denial. This can create even more negativity in their lives because they have to remain open to reason and they have to be willing to accept the help being offered in order to maintain a quality of life that they are accustomed to for as long as it is possible. Changing Relationships with Family and Friends The disease of dementia creates severe strain in familiar relationships with those that the dementia patients use to have a close and friendly relationship with. This is especially true as the disease progresses because they become more forgetful and their ability to communicate in a logical manner gradually declines (Harmon 1999). The third stage of the disease definitely affects family relationships because it is in this stage that the patient is quickly falling into a vegetated state. They lose their ability to recognize familiar faces and even lose the majority of their memories. For example, a daughter can visit her mother and communicate with her about the past and all the trials as well as happy times that they have been through as a family, but the third stage dementia patient does not even recognize this person as their daughter. In fact they might talk to them like they are a complete stranger and there is also the possibility of them becoming agitated and violent as well. Not all third stage dementia patients are easily provoked into anger but it is felt by many of those that study the stages of the illness that due to the adverseness that this disease brings on it compounds negative emotions within the individuals and they become overwhelmed, lacking the ability to cope with their external environment and their condition (Harmon 1999). Personally I have saw how devastating this disease can be in a family. My Uncle was diagnosed with this disease not long ago and my family is currently in a situation where they are attempting to decide what would be the best course of treatment for him. The strain that this has placed on my Aunt and Uncle’s marital relationship is tremendous as they are both older people and my Aunt simply can not continue to provide him the care that he needs although she hates the thought of sending him to a 24 hour nursing care environment. He is now at the point where he starts arguments among family members for no apparent reason and is not the fun loving enjoyable guy that everyone knew and loved. He is very short tempered with my Aunt as well and always appears to be agitated, seemingly not enjoying any activities that he once did. Seizures are another complication that he suffers from and this puts more strain onto the family because these occurrences are indeed scary. It is one of the reasons that everyone is starting to come to the realization that my Uncle needs more support than what he is getting in an in home environment type of situation. Because many patients suffer from many other complications the best solution as the disease progresses is often to place them in a care environment that clearly shows they will receive supportive and sincere care (Katzman & Bick 1978). Due to my Uncles complications already with his dental, digestive, and bowel disorder, it has simply become too much to cope with as many families who have someone with the disease come to realize. Often, placing the loved one in a better environment relieves some of the tension and anxiety in the family so that they can better reserve their energy and release it into more positive issues to help the individual with dementia instead of worrying how to deal with it. It can be very difficult because many families are tightly bound to one another, especially husband and wife relationships, so the decisions that have to be made can be extremely grueling and emotionally hard on the family. Again, on a more personal note, witnessing my Uncle be so cold and cruel to my Aunt at times has really made me bitter in many ways towards him. I do remember the kind and understanding person he use to be but seeing his personality now and how he treats others places tremendous negativity about him in my mind. It is in fact one of the reasons I personally feel that it would be better for him and everyone to have him placed in a 24 hour care environment where he could receive the care that he needs to help him cope with the disease and the progression of it. Maybe then his attitude would change somewhat while he is still able to communicate and have an understanding relationship with the family. Living in a Nursing Home Environment It is true that if a person is placed in a care home in the early stages of dementia it would not be an easy situation to deal with. Basically I feel this way because if it were myself going through such a scenario I would feel abandoned and isolated from my family. I ultimately would feel like I had been too much of a hardship and no one really had the time to help me with my medical condition. In this regard it can be heartbreaking to have to think in this way and I am certain many people who go through this have these exact emotions go through their mind. In many ways I do not think it is fair because these people are still human beings and deserve good quality care and compassion. The stories that have been talked about in the past in regards to nursing homes scare people, they scare me. One can never be sure they are going to be taken care of appropriately and that is the scariest element of them all. For me personally I would be terrified and uncertain if the environment would be something I would want for the rest of my life, however long that might be. But then again I would have no say so over where I would be placed which again is something that is totally unfair in my mind. If a person with dementia still has some competency about them then I feel it is only fair to them that they are allowed to have some say over their medical care and where they are going to be forced to live at as well. This is at least what I would want for myself and if I feel this way I am sure others do as well. Appropriate Care by Staff and other Medical Professionals An abundances of studies on the caring of individuals with dementia has shown that care providers need to provide understanding, support, and direct therapy for a dementia patient on a regular basis to maintain the best quality of life for as long as possible (Wolstenholme 1970). In order for a dementia patient to feel that they still have some form of independence in their life caregivers need to ensure that they are in an environment that is not binding to them, where they are free to walk outside or explore the corridors in the building of their own free will. Also, I feel that if it were myself I would want to be encouraged in therapy and to interact in activities that would help me keep a strong grasp on my personal perception of activities around me for as long as possible. I would not want to simply sit in a corner of the nursing home lobby and smile at people, feeling forgotten and uncared about like a majority of dementia patients do. The disease is severe and in the early stages many research studies have verified that there are ways in which care givers can help the patients cope better with such a dehabilitating illness. Again, therapeutic intervention such as swimming, engaging in board games, arts and crafts, and other activities that force the cognitive processes of the mind to work are necessary in trying to keep a patient as competent for a good period of time. Unfortunately it is well known that no matter how much intervention is given the disease is still going to gradually progress but that does not mean that the care giver can not continue to be supportive and caring instead of appearing to show that it is becoming somewhat of a drudgery and a boring but difficult managing care routine. Care givers need training to prepare them for the changes that take place within a dementia patient and they need to have a sympathetic heart to these patients because all in all these are human beings that at one time carried out their lives just like anyone else did. The big question is, how would another person want to be treated? I’m certain no one would want to be left to feel insignificant or uncared for and this is a major problem in many nursing home environments. In summation, the literature presented in this paper has focused on the needs of the dementia patient and the changes that occur during the progression of the disease. Alzheimer’s is a disease that is very serious and has become a potential problem for all people when they grow old. However there is very limited knowledge about the disease and care givers don’t have much to go on when attempting to provide the correct type of care but they can always be sympathetic to the needs of the patient and genuinely concerned for their wellbeing despite the limited scientific information. Dementia has an impact on everyone involved including the families and the care providers as a joint team. Furthermore, in order to affectively assist the patient in the most efficient way possible early and accurate diagnosis is crucial because of the life-long impact of the condition that adversely affects the sensory, motor language, communication, and intellectual abilities of the dementia patient. Therefore proper attention to the patients individuals needs are the essential key tools in the maintenance of the quality of life with the aging person. It would be the support for all involved that would be the most influential in providing a positive outcome for everyone in a family disease such as dementia. References Beach, Thomas. (1987). The History of Alzheimer’s disease: Three Debates. Journal of the History of Medicine and Allied Sciences, 42, 327-349. Beckleman, Laurie. (1990). The Facts about Alzheimer’s Disease. New York: Crestwood House Publications. Frank, Julia. (1985). Alzheimer’s Disease: The Silent Epidemic. Minneapolis: Lerner Publications. Harmon, Dan. (1999). Life out of Focus: Alzheimer’s Disease and Related Disorders. Philadelphia: Chelsea House Publications. Katzman, R. & Bick, Terry. (1978). Alzheimer’s Disease: Senile Dementia and Related Disorders. New York: Raven Press Publications. Lezak, Muriel. (1995). Neuropsychological Assessment. (3rd Edition) New York: Oxford University Press. Terry, Robert. (1988). Advances in the Diagnosis of Dementia: Accuracy of Diagnosis and Consequences of Misdiagnosis of Disorders Causing Dementia. Aging and The Brain. New York: Raven Press. Wolstenholme, GEW. (1970). Alzheimer’s Disease and Related Conditions. London: Churchill Publications. Vinkers, D. J., et al. (2003). Leisure Activities and the Risk of Dementia. New England Journal of Medicine, 349, 1290-1929. Read More